Pre Exercise Questionnaire

Please answer some basic information about yourself prior to booking an appointment with us, as at CCKM, we like to ensure all activities is personalised for each person. This information ensures we understand a little of your needs and goals prior to you meeting with us.

First name:

Last name:

E-mail:

Phone:

Preferred contact method:

How did you hear about us:

DOB:

Programs interested in:

Current training:

What type of exercise?:

How long have you done this?:

Allergies:

Injuries/Medical:

Any other factors that impacts your training?:

Any medication required to assist your condition?: